<div class="row-content deaf">
	<div class="content-left">
		<div class="row-content register-header">
            <div class="heading"></div>
            <div class="desc">You will be set up as a User Profile once you have registered your details.</div>
        </div>
        <div class="row-content register-content">
            <?php echo Form::open(array ('action' => '', 'class' => 'deaf-register')); ?>
            <div class="fieldset">
                <div class="legend">Contact Details:</div>
                <div class="fieldset-content">
                    <div class="row row-form">
                        <div class="row-label">
                            <label class="label">Mobile Number:</label>
                        </div>
                        <div class="row-content">
                            <?php echo Form::input('mobile_number') ?><label class="inline">*</label>
                        </div>
                    </div>
                    <div class="row row-form">
                        <div class="row-label">
                            <label class="label">Home Address:</label>
                        </div>
                        <div class="row-content">
                            <?php echo Form::input('home_address') ?><label class="inline">*</label>
                        </div>
                    </div>
                    <div class="row row-form">
                        <div class="row-label"></div>
                        <div class="row-content">
                            <?php echo Form::input('home_address_1') ?><label class="inline">*</label>
                        </div>
                    </div>
                    <div class="row row-form">
                        <div class="row-label"></div>
                        <div class="row-content">
                            <?php echo Form::input('home_address_2') ?><label class="inline">*</label>
                        </div>
                    </div>
                    <div class="row row-form">
                        <div class="row-label">
                            <label class="label">Country:</label>
                        </div>
                        <div class="row-content">
                            <?php echo Form::select('country_id', null, $countries) ?><label class="inline">*</label>
                        </div>
                    </div>
                    <div class="row row-form">
                        <div class="row-label">
                            <label class="label">Postcode:</label>
                        </div>
                        <div class="row-content">
                            <?php echo Form::input('post_code') ?><label class="inline">*</label>
                        </div>
                    </div>
                </div>
                <div class="legend">Your communication details:</div>
                <div class="fieldset-content last">
                    <div class="row row-form">
                        <div class="row-content">
                            <label class="label">What is your preferred way of communication?</label>
                        </div>
                    </div>
                    <div class="row row-form">
                        <div class="row-content">
                            <?php echo Form::select('communication_id', null, $communications) ?>
                            <label class="label">*</label>
                        </div>
                    </div>
                    <div class="row row-form">
                        <div class="row-content">
                            <label class="label">What is your most preferred way of communication support?</label>
                        </div>
                    </div>
                    <div class="row row-form">
                        <div class="row-content">
                            <?php echo Form::select('communication_support_id', null, $communications) ?>
                            <label class="label">*</label>
                        </div>
                    </div>
                    <div class="row row-form">
                        <div class="row-contnet">
                            <label class="label">What is your second preference?</label>
                        </div>
                    </div>
                    <div class="row row-form">
                        <div class="row-content">
                            <?php echo Form::select('second_preference_id', null, $preferences) ?>
                            <label class="label">*</label>
                        </div>
                    </div>
               </div>
            </div>
            
            <?php echo Form::submit(null, null, array('class' => 'create-account')) ?>
            <?php echo Form::close() ?>
        </div>
	</div>
	<div class="content-right">
		<?php echo Asset::img('files/ads.jpg', array('class' => 'fl mb20')) ?>
	</div>
</div>